Primary cutaneous coccidioidomycosis: an incidental finding

Abstract

Conflict of interest: none declared. A 77‐year‐old immunocompetent man residing in southern New Mexico presented for a routine skin cancer screening examination. His medical history was significant for several nonmelanoma skin cancers. During the examination, two lesions were found, which were suspected to be basal cell carcinomas (BCCs): a 2.5‐mm pink papule on the right chin and a 6 × 8‐mm thin pink papule on the left lower back (Fig. 1a). Histological examination of biopsy samples taken from the lesions confirmed the clinical diagnosis of BCC for the right chin papule, but the left lower back lesion had a granulomatous infiltrate in the dermis with spherules diagnostic of coccidioidomycosis (Fig. 1b,c). The patient had been unaware of the lesion on the left lower back until it was identified during the skin‐screening examination. After discussing the diagnosis with the patient, he recalled that 5 months earlier he had been working in his yard pruning trees and had sustained a puncture wound from a mesquite branch to the area of concern on his left lower back. After the area had healed, it remained asymptomatic and he ‘forgot about it’. He reported that he was currently feeling well and did not recall any flu‐like illness or respiratory symptoms at the time of the injury or subsequently. Physical examination found no evidence of local induration, regional adenopathy or evidence of lymphangitis.